<div class="row">
    <div class="col-xs-12">
        <div class="panel panel-midnightblue">
            <div class="panel-body">
                <form action="" class="form-horizontal row-fluid"  data-validate="parsley" id="validate-form">
                	<div class="row">
                		 <div class="form-group">
                    		<label class="col-sm-3 control-label" >姓名/手机/卡种/卡号:</label>
                    		<div class="col-sm-8">
                    			<input type="text"  disabled class="form-control" value="{$member.name}/{$member.mobile}/{$order.gym_card_name}/{$order.card_no}"/>
                    		</div>
                   		 </div>
                	</div>
                	
                	<div class="row">
                		<div class="form-group">
	                		<label class="col-sm-3 control-label"  >选择卡种:</label>
	                		<div class="col-sm-8">
			                    <select class="form-control"disabled  style="width: 100%;">
			                      <option value="0">{$order.gym_card_name}</option>
								</select>
							</div>
						</div>	
                	</div>
					
                	<div class="row">
                		 <div class="form-group">
                    		<label class="col-sm-3 control-label" >有效期开始:</label>
                    		<div class="col-sm-8">
                    			<input type="text"   disabled value="{$order.start_date}"  class="form-control"  />
                    		</div>
                   		 </div>
                	</div>
                	
                	<div class="row">
                		 <div class="form-group">
                    		<label class="col-sm-3 control-label" >有效期结束:</label>
                    		<div class="col-sm-8">
                    			<input type="text" disabled   value="{$order.end_date}"  class="form-control"  />
                    		</div>
                   		 </div>
                	</div>
                	{eq name="order.gym_card_type" value="1"}
						<div class="row">
                		 <div class="form-group">
                    		<label class="col-sm-3 control-label" >剩余次数:</label>
                    		<div class="col-sm-8">
                    			<input type="text"  readonly  name="able_count" id="able_count"  value="{$order.able_count}"  class="form-control" />
                    		</div>
                   		 </div>
                		</div>
					{/eq}
                	
					{eq name="order.gym_card_type" value="2"}
						<div class="row">
                		 <div class="form-group">
                    		<label class="col-sm-3 control-label" >剩余天数:</label>
                    		<div class="col-sm-8">
                    			<input type="text"  disabled id="able_day"  value="{$able_day}"  class="form-control" />
                    		</div>
                   		 </div>
                		</div>
					{/eq}
					
					{eq name="order.gym_card_type" value="3"}
						<div class="row">
                		 <div class="form-group">
                    		<label class="col-sm-3 control-label" >剩余金额:</label>
                    		<div class="col-sm-8">
                    			<input type="text" name="able_money" disabled id="able_money"  value="{$order.able_money}"  class="form-control" required="required" />
                    		</div>
                   		 </div>
                		</div>
					{/eq}
					
					<div class="row">
                		 <div class="form-group">
                    		<label class="col-sm-3 control-label" >支付金额:</label>
                    		<div class="col-sm-8">
                    			<input type="text"  disabled  value="{$order.pay_money}"  class="form-control"  />
                    		</div>
                   		 </div>
                	</div>
                	
                	<div class="row">
                		 <div class="form-group">
                    		<label class="col-sm-3 control-label" >支付方式:</label>
                    		<div class="col-sm-8">
                    			<?php  $pay_types=config('pay_type'); ?>
                    			<select  disabled  class="form-control" >
                    				{foreach name="pay_types" item="v" }
                    					<option value="{$v}" {eq name="order.pay_type" value="$v"}selected{/eq}>{$v}</option>
                    				{/foreach}
                    			</select>	
                    		</div>
                   		 </div>
                	</div>
                	
                	
                	<div class="row">
                		 <div class="form-group">
                    		<label class="col-sm-3 control-label" disabled >退会时间:</label>
                    		<div class="col-sm-8">
                    			<input type="text"   name="order_date"  value="<?php echo date('Y-m-d')?>"    class="form-control datepicker"  />
                    		</div>
                   		 </div>
                	</div>
                	
                	<div class="row">
                		 <div class="form-group">
                    		<label class="col-sm-3 control-label" >退款金额:</label>
                    		<div class="col-sm-8">
                    			<input type="text" name="refund"   value="0"  class="form-control"  />
                    		</div>
                   		 </div>
                	</div>
                	
                	<div class="row">
                		 <div class="form-group">
                    		<label class="col-sm-3 control-label" >退款方式:</label>
                    		<div class="col-sm-8">
                    			<select  name="refund_type"   class="form-control" >
                    				{foreach name="pay_types" item="v" }
                    					<option value="{$v}" {eq name="order.pay_type" value="$v"}selected{/eq}>{$v}</option>
                    				{/foreach}
                    			</select>	
                    		</div>
                   		 </div>
                	</div>
                	
                	<div class="row">
                		<!-- parsley.min.js -->
                		 <div class="form-group">
                    		<label class="col-sm-3 control-label" >描述:</label>
                    		<div class="col-sm-8">
                    			<textarea  placeholder="描述" rows="3"   class="form-control" name="descs" id="descs"></textarea>
                    		</div>
                   		 </div>
                	</div>
                	<input type="hidden" name="order_id" value="{$order.id}" />
                	<input type="hidden" name="gym_card_type" value="{$order.gym_card_type}" />
                	<input type="hidden" id="member_id" value="{$order.gym_member_id}" />
                    </form>
                </div>
                
                <div class="panel-footer">
	                <div class="row">
	                    <div class="col-sm-6 col-sm-offset-3">
	                        <div class="btn-toolbar">
	                            <div class="row">
			                		 <div class="form-group">
			                    		<div class="col-sm-3">
			                    			 <div class="btn-primary btn" id="form-submit">退会</div>
			                    		</div>
			                    		<div class="col-sm-3">
			                    			 <div class="btn-default btn" data-dismiss="modal">关闭</div>
			                    		</div>
			                   		 </div>
	                			</div>
	                        </div>
	                    </div>
	                </div>
            	</div>
                
            </div>
        </div>
    </div>
</div>
<script type='text/javascript' src='{$Think.GYM_VIEW_JS}gym_member/member_out.js'></script>